Marilyn B. Benoit, M.D.

Abstract

This paper presents a number of psychological issues that could influence the behaviors of teenagers who become parents out of wedlock. It addresses normative adolescent psychological development, emphasizing the developmental thrust towards separation, but juxtaposes the deviant psychological development of teenagers who are unable to gain control of their childbearing. The impact of early childhood experiences, the role of parents as models, family experiences, social class, changing societal sexual mores, urban living, education and a sense of future are explicated. Particular focus is given to the different experiences of female and male teenagers and the meaning of parenthood to each. The influence of cognitive challenges and of specific psychiatric illnesses is also addressed. The paper concludes that social policy should integrate an understanding of these issues in the crafting of domestic policy on teenage parenthood.

Introduction

The issue of out-of-wedlock teenage parenthood in the United States has been an increasingly troubling one. Though the most recent data from the Centers for Disease Control reveal a downward trend, unwed teenage mothers and their children have been a major burden on the welfare system. Some 11% of teenage girls between the ages of 15 and 19 become pregnant each year, accounting for approximately 1 million pregnancies. The 104^th Congress took an unprecedented and bold step in crafting legislation, signed by the president, to begin to contain spending on welfare mothers and their children. The Child Welfare League of America, the Children’s Defense Fund, and other child advocacy organizations were outraged by this legislative step endorsed by the president. The passage of this bill was so unpopular with some of the president’s top appointed administrators that some left rather than continue to serve in his administration.

The sharpest criticism has been that the legislation has removed the safety net from the children of welfare mothers who must now seek work two years after initiating welfare or face loss of benefits. No doubt, such a draconian measure was one born out of the failure of attempts at varied social programs to effect any large- scale reduction in teenage childbirth. Education, availability of information, and availability of contraception have all failed to change the reproductive behavior of those with the most intractable problems. In her book Dubious Conceptions, K. Luker (1996) states, "But careful and rigorous review of all the various studies on the matter suggests that, in general, taking sex education courses has virtually no effect on an individual’s propensity to become sexually active" (p. 186). Because of the difficulty encountered in "helping" this group of welfare-dependent teenage mothers to gain control of their fertility and, hence, to exercise better control of their lives, it is necessary to understand the intrinsic psychological forces that seem to fuel such socially maladaptive behavior.

Brief Overview of the Adolescent Passage

It is critical to our understanding of teenage parenthood that we understand that the teenage parents referred to are not adults. First, it is important to distinguish between adolescence, which refers to the psychological process of development, and puberty, the onset of sexual maturation. Adolescence, the psychological process of maturing, spans the years from 12 to 19 (for the average person). In the pre-industrial, agrarian era there was a convergence of sexual and psychological maturation. At that time children were considered to be economic necessities. They were needed to provide labor on the farm and, in that way, they contributed to the economic survival of the family. Teenage marriages were not uncommon and, without easy availability of contraception, childbearing took place early. Erik Erikson (1950) states that the desired outcome of adolescence is identity formation. In the pre-industrial era, young men and young women, some still in their teenage years, would bring adolescence to closure with the formation of identities as husbands, wives, parents, and economic providers.

With the decline of the agrarian and industrial eras, the prolonging of education, the growth of cities, and the mass migration to them, the social infrastructure within which puberty and adolescence are played out has drastically changed. No longer do puberty and adolescence converge neatly. In fact, biological maturation is long completed while teenagers are still battling the conflicts of adolescence and are far removed from the identity consolidation that tends to come several years later. A brief review of the intrinsic psychological issues of adolescence seems appropriate at this point.

Uncomplicated adolescence is divided into three stages. The first stage, from 12 to 14 years of age, heralds in the movement toward independence, when friends assume a very significant role in the youngster’s life. Action takes precedence over thought, and immediate gratification is sought. There is the beginning of an interest in the opposite sex, but usually a safe distance is kept from members of the opposite sex while more energy goes into fostering same-sex relationships. This is when the sixth- and seventh-grade girls travel in packs, and the boys seek safe refuge in their all-male groups, forming secret clubs, as illustrated in the movie Stand by Me.

Some rule-breaking is common as these early teenagers try to create a world that excludes both their parents and the childhood world that they struggle to leave behind. It is, paradoxically, a period of loss and longing for that very world of childhood, when early dependency needs were unconditionally met. They seek increasing autonomy and may demonstrate periods of almost adultlike behavior punctuated by some brief episodes of childish regression. Those adolescents who have "stored up" a reservoir of sufficiently good caring from their parents and other significant family members are able to cope with the loss and longing without major dysfunction. For those who have not had adequate nurturing in earlier years, however, this can be a time of heightened vulnerability. Emotionally deprived youngsters might attempt to soothe the pangs of psychological loss by responding to sexual biological urges and by prematurely entering into intimate physical relationships.

Middle adolescence, from age 14 to 17 (Blos, 1962), is marked by an increasing intensity of separation from parents, with the emergence of more conflict with parents, who become devalued in the teenager’s perception. This is a period of heightened narcissism, a feeling of grandiosity, and a sense of invulnerability that is facilitated by a pervasive use of denial. The teenager at this stage angers parents, who often complain of his or her selfishness and arrogance. Parents feel exploited and unloved and experience a heightened anxiety as they learn of their teenagers’ risk-taking behaviors. The adolescent experience of loss of the parents intensifies and cognitive capacities increase as abstract thinking (Pulaski, 1971) becomes a new tool available for coping with psychological distress. Teenagers who have grown up in environments that encourage and facilitate expression of thought (oral or written) as an alternative to action may resort to keeping journals in which they record their sometimes confusing, conflicting and fluctuating feeling states. Where such a psychologically healthy outlet (referred to as sublimation) is not available to a youngster, impulsive action may be the outcome of distressing feeling states.

P. Trad (1995) states that "The epidemic of adolescent pregnancy is augured by high rates of sexual activity" (p.133). Because heightened sexual urges (and surges) are characteristic of this stage of biological maturation, an impulsive teenager without adequate alternatives for sublimation or adequate social constraints to abstain from sexual behavior may seek outright gratification--without pondering the consequences of his or her behavior. Teenagers who have a sense of a career in the future begin thinking about what preparation they must set in motion to achieve their goals. For example, they consider taking the preparatory college admission tests. They begin thinking about the extracurricular activities they would need to gain admission to the college of their choice. This sense of future begins to influence their behavior. It is indeed this sense of future that serves a moderating function at those times when impulsivity and the wish for instant gratification push for action. With respect to sexual behavior, responsible use of contraception might be the step the teenager will take to avoid unwanted parenthood. For those teenagers who do become pregnant, choosing abortion versus childbearing may be preferable in order to carry through with career plans for the future (Luker, 1996). A study by P. Trad (1995) found that among teenage mothers there was a significant deficit in ability to preview the future.

For middle-class teenagers, adolescence is prolonged for as long as they choose to stay in school, develop careers, and delay marriage and childbearing. For many poor youngsters, however, for whom the future holds little or no promise, early school dropout and unemployment may mark the end of adolescence, which is more likely than their middle-class counterparts' to come to premature closure with early parenthood. This is not to say that middle-class teenagers do not engage in sexual behavior that results in pregnancies. The difference is that there is less likelihood that the middle-class teenage girl would bring her pregnancy to term because of the interference it is likely to impose on her future life plans.

The third stage of adolescence spans the years 17 to 19 and results in a firmer sense of one’s identity, a commitment to career development, an ability to make independent decisions, and a growing capacity for thoughtfulness, reflection, regulation of emotional states, problem solving, and insight. The psychologically mature teenager develops a sense of purpose (for example, going to college for some future profession, learning a trade, getting an entry-level position with the hope of working one’s way up, getting married and having a family) and begins to identify with the broader social values and cultural traditions.

Fragmentation of the Family

The brief normative development thus described is more likely to take place in teenagers who have the benefit of growing up in a stable and nurturing family. Because of the remarkable economic and social changes of the past two decades, there has been significant fragmentation of the family across all socioeconomic strata. This phenomenon has occurred in both rural and urban settings. The high divorce rate, the necessity for both parents to work outside the home, high unemployment, low vocational training and the mediocrity of the educational system, rising drug abuse, the ravages of AIDS, and domestic and community violence are all factors that have contributed to the destabilization of the family.

Family structure has suffered tremendously, and nowhere has the devastation been more evident than in those families at the bottom of the socioeconomic stratum: those who are chronically the most vulnerable in society. As a result, whereas the family used to provide a stable emotional holding environment within which adolescence was negotiated, now youngsters are left quite early on in life to "fend for themselves" without the benefit of stable psychological structures in place. Whereas the agrarian and the industrial family allowed for contributory roles for all able-bodied members, the now post-industrial family has fewer economic roles for adolescents to assume. In some cases the parents of adolescents no longer have the skills to stay employed. In the high technology world that we live in, sophisticated technical skills and at least a high school diploma are essential for developing any type of career. More recently, President Clinton has actually proposed that two years of college education should replace the standard of a high school diploma as a yardstick of the average expected education for all Americans.

Psychology of Adolescence

What exactly are the psychological structures that should be in place in order to negotiate adolescence successfully? Foremost is the emotional stability gained from having parents who have been consistent and adequate providers of both the physical and emotional needs of the growing child. In other words, dependency needs must have been satisfactorily met. This is critically important, because one of the essential conflicts of adolescence concerns the bipolar tension between the teenager’s wishes to regress and be dependent and his or her wishes to be absolutely grown up and free of any dependency on his or her parents. The more adequately earlier dependency needs have been met, the better prepared is the teenager to struggle through this dependency-independence crisis and emerge as a relatively well-functioning adult.

Where there has been significant early deprivation, however, and the dependency needs of adolescence are intense (because they really reflect the needs of a much earlier developmental stage), the teenager is vulnerable to acting out behaviors that, while playing out those needs, deceptively give the illusion of adult behavior. For example, becoming pregnant offers that "opportunity" in almost a perfect manner. Engaging in what seems like "adult" behavior (such as having sexual intercourse) is appealing and has the capability of temporarily gratifying the earlier childhood dependency needs for physical closeness and perceived caring. In an intriguing way, having unprotected sex--that is, not using any contraceptive method--further plays out, and simultaneously meets, the teenager’s conflicting psychological needs. While having sex may be "acting grown up," to go all the way and plan to do so (as a responsible adult who takes control of his or her fertility) would be acting too much like an adult and would allow no room for the "irresponsible child" to do its (unconscious) acting out. Additionally, the normal tendency of adolescents to engage in impulsive behavior, simply by reason of their developmental stage, only further facilitates risky sexual activity.

Clinical Examples

It is important to realize that control of one’s impulsivity--that is, delaying gratification--is facilitated by the knowledge that, by so doing, one ultimately has more to gain. But that attitude requires a sense of future: a future into which one can project oneself with some sense that good things are indeed possible. A few clinical examples will illustrate the point. One teenage girl, seen by this author in psychotherapy, demonstrated how psychotherapeutic intervention helped her to avoid sexual acting out. She had been the product of a teenage pregnancy and, because of her father’s early and untimely death secondary to drug abuse, had been raised by a single mother who never remarried. Her paternal grandmother was consistently available as an important emotional resource. She abstained from sexual behavior throughout early and middle teenage years.

After high school graduation she entered the workforce at an entry-level office job. She was a bright, diligent, and highly productive worker who was targeted for career development in the company. After she had been dating the same boyfriend for several months, she gave some consideration to starting a sexual relationship with him. The couple spent a great deal of time discussing initiating such a relationship, and the patient sought a gynecological consultation to do contraceptive planning prior to their first sexual encounter. What this young lady admirably demonstrated was an unconflicted acceptance of herself as a young adult who was exercising responsible and conscious choice over her sexual behavior. Unconscious, intrinsic psychological issues were not allowed to play havoc with and drive her sexual behavior.

In another case, a teenager who was sexually active and came from a lower socioeconomic background was highly conflicted about the issue of becoming pregnant. She lived in a violent neighborhood and had actually witnessed the murder of someone known to her. She had graduated from high school and was contemplating going to college. Her boyfriend, however, fathered a child by another young woman while dating her. It was surprising to me that her reaction to this event was not outrage at his infidelity-- but, rather a consideration of having a child herself. One of the reasons she gave for possibly choosing to do so was the fact that she felt her life could be truncated by a bullet in the violent neighborhood in which she lived. She stated that should that be the case, at least she would have left a child behind to carry on. It became clear that in this particular case a child could represent the only tangible sense of future this teenager could envision. It is possible that this psychodynamic process may be repeated many times over in the population of intractably welfare-dependent teenage mothers. Only research will be able to explore this line of enquiry.

The third case is that of a fatherless preteen girl who became a ward of the state after abandonment by her drug-addicted mother (herself having been a teenage mother). Within months after her menarche, this girl began expressing her wish to become pregnant and have a child. Her fantasies revealed that she expected she would have a daughter whom she would never leave and to whom she would provide the best care possible. From a psychodynamic point of view, this girl wished to take corrective action for the failure of her mother and father as parents by giving birth to a daughter who would really be representative of herself. By vowing never to abandon her fantasized child, she would unconsciously repair both the parental failures and her own experience of neglect.

Discussion

Given that adolescence as a developmental stage has some inherent barriers that produce resistance to adult, logical thinking, it is unlikely that an education campaign against teenage parenthood will ever be effective in significantly lowering the rate of teenage childbirth. The identified welfare-dependent population is vulnerable to teenage parenthood as an outcome. Based on the above discussion, some of the preexisting, intrinsic, psychological dynamics that predispose these vulnerable teenagers to early childbirth are:

(1) Unmet early dependency needs--these teenagers are very likely to have been themselves the children of teenage parents who were not psychologically equipped to take on the demands of childbearing.

(2) The wish to appear as adults, while simultaneously wanting to remain as children. This, of course, is a developmental conflict typical of all adolescents. These particular adolescents, however, are more likely to move precociously into pseudo-adulthood because they cannot admit to the dependency hunger they experience. Sexual behavior and parenthood are believed to be open proclamations of one’s adulthood.

(3) Denial of parenthood risk. This holds true for adolescent sexual behavior in general, and is not exclusive to any social class; nor is denial of risk and vulnerability limited to sexual behavior (witness the high rate of automobile accidents among teenagers). Denial as a defense mechanism is inherent in adolescent psychological functioning.

(4) Denial of the demands of babies. While this is true for all parents-to-be, it is exaggerated in teenage parents. Emotionally deprived teenage mothers are especially susceptible to the maximum use of denial of this aspect of mothering because they vicariously hope to satisfy their own needs to be taken care of through their babies. In fact, it is not unusual that having a baby serves to engage the teenager’s own mother into providing mothering to both the teenage mother and her child. Because of the teenage mother’s earlier deprivation, the difficult, negative aspects of childbearing must be kept out of conscious awareness. For the females, childbearing serves as a psychologically economical way in which to believe on the one hand that they have grown up, while on the other hand allowing them to maintain the hope that their children will be better taken care of than they had been as children. They identify with their own mothers who often were themselves teenage mothers.

(5) For the males, becoming a father is, in and of itself, an attainment of some psychological sense of manhood (Anderson,1990). The abrogation of any financial responsibility for their children could allow for psychological repetition of similar experiences they themselves have often had as children, when their own fathers rejected them. This ability to do unto others the negative things that were done unto them is a phenomenon referred in psychology as "identification with the aggressor."

(6) For both males and females the unconscious acceptance of dependency on the government to provide for the basic needs of their children and themselves can be a way of psychologically gratifying their own needs to be taken care of by an all- powerful, ever-present, consistent, and dependable caregiver. In other words, government can psychologically become the surrogate parent. Because these are the very people who feel disempowered (because of poverty or racism, poor education, and unemployment) and have a view of their world as hostile and unforgiving, there may be unconscious, and perhaps at times even conscious, triumph over the system that they experience as their oppressor. Passive dependency gratifies the psyche that feels powerless.

It is important to address other intrinsic psychological cognitive and emotional factors. Such factors have more to do with the teenager’s level of intelligence or the presence of psychiatric illness (McCue, Horwitz et al., 1991, McGee et al., 1990), both of which may compromise the teenager’s ability to make thoughtful judgments before engaging in unprotected sex. Low intelligence results in a restricted ability to understand and master the environment, to plan for the future, to consider alternatives, and to delay sexual gratification. Learning disabilities may also significantly compromise the way in which a teenager processes, interprets, and responds to information. Whether or not and to what extent responsible sexual behavior is affected is a matter of speculation, but cognitive ability is one variable that does indeed affect judgment.

Major psychiatric illness in an otherwise not cognitively compromised person also interferes with judgment and mastery of the environment. For example, teenagers who have been victims of sexual abuse (and may have an underlying chronic, unresolved, post-traumatic stress disorder) may engage in impulsive, promiscuous sexual behavior. Such behavior may result in unplanned pregnancies in an unconscious effort to maladaptively gain some psychological mastery over their sexual victimization (Fine, 1992). A depressed, lonely teenage girl may seek solace and comfort in sexual behavior, while a hypomanic teenager (male or female) may be sexually promiscuous as an expression of hypersexuality that is part of the symptom complex of bipolar mood disorder (DSM IV, 1994). Those who have impulse control disorders, which may coexist with or are exacerbated by substance use, are extremely susceptible to engaging in high-risk sexual behavior without any concern about the consequences. When one considers that this population already lives under poor social conditions that are a breeding ground for feelings of hopelessness and helplessness, the risk increases even further (Trad, 1995).

Some social issues that further compound the intrinsic factors at work are the prevailing social values of the neighborhood and of society at large. Where, in neighborhoods, it is socially acceptable for teenagers to bear children, and there may actually be elevated social status attained by reason of early parenthood, there are no intrinsic deterrents such as guilt and shame to prohibit behavior leading to teenage childbearing. In one example brought to the attention of this author, a young, unmarried mother whose child was the product of a teenage parenthood was pressured by the women in her inner-city, poor neighborhood to quit her job, go on welfare, and stay at home in order to be respected as a good mother by her peers. She was attempting to take some adult education courses and prepare herself for upward social mobility. She had to tolerate tremendous conflict, however, as she struggled with the feelings of isolation resulting from her rejection of the values of her social peers, who accused her of trying to be "uppity." The support of her supervisor at work proved to be critical and invaluable in helping her to resist such social and psychological pressure. She managed to arrange a satisfactory day-care arrangement, which the child’s father assisted in implementing, and continued her schooling. Though she continues the pursuit of her education, it is interesting to note in follow-up that she went on to give birth to yet another child as an unwed mother. Her behavior demonstrates that she remains conflicted about her choices.

The population of teenagers with children on AFDC represents a group that, in spite of the rhetoric of equal opportunity for all, feels disenfranchised and powerless to attain the goals of higher education and decent job opportunities that children of the middle and upper classes believe they can attain. In other words, their perception of available alternatives is extremely constricted. This holds true for both the teenage boys and the girls.

I wish to emphasize (for those who will argue that opportunities do indeed exist) that the powerful intrinsic psychological dynamic that is operant here is the adolescent’s perception. Those of us who are raising, have raised, or have friends who have teenagers know that even teenagers whom we designate as relatively normal and who perceive that they have access to opportunities still have a perception of reality that can get pretty distorted. Such is the nature of adolescence. Simply informing teenagers that job opportunities exist does not necessarily mean that they have become aware of such opportunities. For those in the lower class who have difficulty perceiving themselves as having membership and, hence, acceptance in mainstream society, such perception is further compromised.

Over the past 30 years we have witnessed a significant and radical shift in the societal acceptance of premarital sex and of children born out of wedlock. This holds true across all socioeconomic strata. This change in values has removed what was once a powerful extrinsic social sanction against unmarried, single motherhood. The result has been a diminunition of a powerful intrinsic psychological deterrent: the anticipation and fear of shame. No more is anyone supposed to endure the humiliation of Hester in the Scarlet Letter. The attitudinal and sociocultural changes of the magnitude that took place with the introduction of the birth control pill into the middle and upper classes have had far-reaching, unanticipated social consequences. As Erik Erikson points out so well in his book Childhood and Society (Erikson, 1950), there is a powerful dynamic interaction between the prevailing societal values and the children we raise in any given society.

Conclusion

If we are to effect any significant, long-term improvement in our teenage parenthood rates, and ultimately on the number of welfare-dependent teenage mothers, we must design efforts to address all the aforementioned powerful, intrinsic psychological issues at work. Some local efforts are currently claiming initial success with teenagers where the focus is on sexual abstinence, delay of sexual activity beyond the teenage years, and use of condoms for the sexually active. It is impossible to provide psychotherapeutic intervention to all the teenagers at risk. It is possible, however, to craft intervention that integrates a significant psychological (psychodynamic and behavioral) component, along with the other programmatic details of providing transportation, food, social-skills training, job training, parent- readiness training, and child-development classes. Simultaneously, on a broader community and societal level, plans for long-term attitudinal changes similar to those successfully achieved with the anti-smoking campaigns must be given serious consideration. Meanwhile, much tolerance and patience will be required while, as a society, we ethically attend to the needs of the vulnerable children who are born as a result of impulsive and irresponsible sexual behavior.

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